Inspection on 25/09/06 for Alpha Community Care

This inspection was carried out on 25th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alpha Community Care 25/06/08

Alpha Community Care 27/03/06

Similar services:

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Hillview Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alpha Community Care Green Tiles Home 5 Green Lane Stokenchurch Bucks HP14 3TU Lead Inspector Mr Rob Smith Unannounced Inspection 25 September 2006 11:30 th Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alpha Community Care Address Green Tiles Home 5 Green Lane Stokenchurch Bucks HP14 3TU 01494 482229 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alpha Medical Care Limited Ms Elizabeth Quaccoo-Walker Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th March 2006 Brief Description of the Service: Green Tiles is a small four bedded home intended to provide long-term accommodation for up to four adults with learning disabilities. The home is run by Alpha Medical Care Limited and is their first venture into provision of residential care. The home is located in a quiet residential area on the outskirts of Stokenchurch, a small village approximately 10 miles from the large town of High Wycombe and 20 miles from the city of Oxford. The home consists of a converted bungalow with four bedrooms, one an ensuite, large lounge, kitchen, dining room and staff office. At the time of this inspection one service user was living at the home. The home charges in the region of £1500 - £2000 per week for placement, with final figures being dependent on the assessed care needs of individual service users. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit. The visit involved talking with the manager and other staff on duty, looking at a selection of staff, home and individual records and meeting the service user who lives at the home. The service user was not able to talk directly with the inspector because of the impact of his disability. The inspector also looked around the building. The inspector had also considered the information that had been sent in by the manager about the home before this visit took place. What the service does well: What has improved since the last inspection? What they could do better: The home needed to make sure staff induction training and training in protection of vulnerable adults was planned and undertaken in the near future to make sure all the staff team were properly prepared to care for people placed in the home. The home needed to provide better storage for medication to ensure it was kept safe and separate from other stored items. The owners of the home needed to start the monthly visits required under regulations to check that service user were being looked after properly. The home was also encouraged to make the living environment as homely as possible and provide more suitable furniture in one bedroom. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. The needs of prospective service users were appropriately assessed to ensure the home could meet those needs consistently. Service users and family members were able to visit the home and stay on a trial basis to confirm it was the right place for them. EVIDENCE: The home had admitted its first service user approximately one month before this inspection took place. Individual records for that service user showed that a thorough and detailed assessment of need had been carried out before admission. This had involved visits to the service user at home with his family and detailed consultation with family and placing authority. Further discussion with the manager about other prospective service users confirmed that she was committed to ensuring that only service users who needs could be met safely and consistently would be considered for admission. The standard process for the home was to arrange for initial visits by service users and an initial one month trial period for parties on all sides to reassure themselves about the appropriateness of placements made. This process had Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 9 been followed for the new service user and a one month review had just taken place to confirm his placement on a long-term basis at the home. The manager indicated work was still underway on completion of service user accessible guides to the home and its practices. This needed to be completed promptly now that service users were being admitted. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. A good detailed individual care plan was in place for the service user to ensure his care needs were fully and consistently met by the staff team. The service user was, within the context of his disability, encouraged to make decisions about his care planning and arrangements. The expressed ethos of the home supported service users in taking appropriate risks. EVIDENCE: A detailed individual care plan had been put in place for the new service user covering all relevant areas of need based on the initial assessments carried out prior to admission. Due to the very recent nature of the admission no reviews of the plan had yet been appropriate. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 11 The manager indicated that the new service user had been actively involved in the choice of his room and was consulted on a day-to-day basis about matters such as meals, recreational activities, room decor etc. As the first placement was still very much in its early days it was difficult to judge how effectively the home would allow considered risk taking on the part of service users but this was clearly expressed as an intention by the manager. This will be more fully assessed in subsequent inspections. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. Appropriate opportunities were being offered or explored for service users to experience activities relevant to their age. An appropriate level of opportunity was being offered for service users to feel part of the local community. Good support was being offered to enable service users to keep up contact with their family. Service user were being provided with a satisfactory diet aimed at ensuring their good health EVIDENCE: Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 13 The current service user was still attending secondary school and therefore currently receiving good opportunities for peer contact as well as educational input and age relevant activities. Plans were also afoot for looking at further education colleges and/or day centre activities for post school leaving time. School related activities were supplemented by opportunities offered by the home out of school time with visits to local shops and walks to the park etc. The manager was also, as part of care planning, exploring a number of options for organised recreational activities in the area targeted at younger adults with disabilities. There had been a good level of family involvement in the planning and choosing of the care home and initial assessments of needs and a good level of initial contact following placement. Files and other records showed the home had maintained good liaison and communication with family members since placement started. The menu sheet seen during this site visit indicated a good and varied range of meals was being provided. The home was still understandably getting to grips with the detailed preferences of the young man concerned. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. Appropriate levels of personal support were being offered to services users Health care needs were being met appropriately. Medication was being administered safely but the suitability of storage arrangements needed addressing. EVIDENCE: The service user’s care plan identified the areas of support required both in and outside of the home and discussion with staff and scrutiny of records confirmed this was being arranged as required. With only one resident at the present time very good levels of individual support were being offered by the staff on duty. The manager was also exploring the viability of independent advocacy input to support services user in the home. The care plan and actions taken to date by the staff team, for example in relation to healthcare needs, indicated that the service user’s diverse needs posed by his disabilities would be met satisfactorily. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 15 The service user plan identified health care needs clearly and, in conjunction with the school and family, these were being met satisfactorily. The manager indicated an intention to request a review and update of external professional health care assessments. Appropriate registration had now been sought with the local GP and other health services and the manager was noted to be working at smooth transfer and co-ordination of area health authority responsibilities during the course of this inspection visit. Medication was being managed by staff for the one service user in residence. Records showed this was being prescribed and administered appropriately. There were also detailed policies and guidance in place for staff around medication management. Initial induction training on medication management and safety had been provided for staff by the manager who was a qualified nurse. No invasive or complex health care procedures were currently undertaken by staff. Medication was however currently being stored in a general filing cabinet. A specific dedicated medication cabinet needed to be obtained by the home to provide more secure and separate storage facilities. A requirement has been made to address this issue. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. The home was taking account of the views of the service user as far as possible in the conduct of his care. Appropriate systems were in place to help ensure service users were kept safe and protected. EVIDENCE: Although formal consultation over the running of the home was not yet a realistic proposition given the presence of only one service user for only one month, discussion with staff and the manager indicated due account was being given to the expressed views of the current service user in respect of his day to day care arrangements in areas such as room décor, meals choice and activities. The staff team was still learning how best to communicate with the service user as he had limited verbal skills. The service user had been involved in the process of choice of home and future reviews and the person-centred planning approach should help ensure service user views remain central to the care offered. Appropriate policies, procedures and guidance were in place to support staff in the identification and management of any concerns about service user safety and welfare. No such concerns had yet arisen. Training for staff on adult protection matters had largely been limited to initial induction input from the manager. The manager was advised however that additional formal external training on adult protection needed to be provided for all staff as matter of priority. A requirement has been made to address this issue. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 17 Appropriate complaints procedures were in place. No complaints had been made to the home or direct to CSCI. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. The home provided a comfortable, safe and clean environment for service users to live in. EVIDENCE: The home was still in largely immaculate condition and was suitably equipped in terms of space and facilities to meet the needs of the planned service user group. It was comfortably furnished throughout and maintained in a very clean and hygienic state. As discussed with the manager areas of the building did still however look a little sterile and bland and further effort at making both communal and bedrooms areas more homely would be of benefit. It was however positive to note the mural completed by one staff member in the service user’s bedroom to fit in with his interests. It was also noted that a cardboard box was being used as a temporary bedside cabinet – this needed replacement by a proper piece of bedroom furniture. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement was made using the available evidence including a visit to this service. The staff team had varying levels of experience in working in adult care settings and currently had limited levels of formal qualification. Recruitment policies and procedures were appropriate and helped ensure only suitable people were appointed to work in the home. Further attention needed to be paid to induction and training arrangements to ensure staff were able to meet service user needs consistently. EVIDENCE: Due to the delays in securing admission to the home there had been changes in the planned initial staff team. Some team members had experience of working in care settings, others did not, so the manager was ensuring that she was on duty to help, support and guide less confident staff in these early days of the home getting underway. Apart from the manager and one member of staff there was also limited formal qualification in care work, although the manager was clear in her commitment to ensure new unqualified staff progressed through induction and onto NVQ qualification as part of their professional development. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 20 Staffing levels on duty were satisfactory with, currently, two staff on duty when the one service user was at home during day time periods with one member of waking night staff covering the late evenings and nights. As noted earlier the manager was spending more time than originally anticipated at the home to support staff. The manager outlined appropriate plans to expand the staff team and level of cover particularly in the evenings and overnight to meet the needs of a larger, and possibly more challenging resident group. A sample of recent recruitment files showed that apart from some occasional problems with securing satisfactory and timely references recruitment processes were sound. CRB and POVA checks were being obtained prior to commencement of work at the home. Staff training arrangements needed some attention. It appeared that only one member of staff had formally completed her documented induction training with other staff having received more basic ‘on the job’ briefing and guidance from the manager. This was explained as having been largely due to the need to have staff on duty swiftly to care for the new admission, which had reduced the time available for formal induction by the manager. This situation needed to be rectified promptly with appointed staff completing their formal recorded induction as a matter of priority. A requirement has been made to address this issue. Options for managing induction training differently in the future were discussed with the manager. A similar situation had arisen with regard to the key training identified by the home for new staff, with the need to provide staffing cover having overtaken arrangements for the completion of this ‘mandatory’ training. Again arrangements needed to be put in place to ensure that all staff undertook the required training over the course of the next few months. A requirement has been made to address this issue. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. Although very much in its early days the home appeared well run with a clear focus on service user needs. Proper evaluation of the monitoring, review and development of the home was not feasible at this early stage of its operation, however the organisation running the home did need to start regular monthly monitoring visits to ensure standards of care were being effectively monitored. Appropriate systems and practices were in place to ensure service users and staff lived and worked in a safe environment. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 22 EVIDENCE: Discussion with the manager and staff on duty, and observation of practice` and communications during the day of the inspection visit confirmed that the home was being run well with the needs of both staff and service user interest being promoted by the approach and commitment of the manager. This was evident in the careful way admissions were being discussed and planned and in the attention paid to the care planning for the current resident. The manager was suitably experienced in this area of work and indicated to the inspector she had now achieved her formal registered manager NVQ` award. The formal certificate had however not yet been received and the manager was advised to forward a copy to CSCI in due course. Due to the very new nature of the service no evaluation of quality assurance and review systems was undertaken at this inspection. It was noted however that no plans appeared to be in place for commencement of monthly monitoring visits under Regulation 26. As the home was now operational with a service user in residence these needed to start as a matter of priority. Appropriate systems were in place to check all key areas of health and safety. Fire safety checks were being undertaken, as were regular water temperature checks. Hazardous substances were being safely stored and COSHH information was available for staff. The manager was continuing to develop the range of health and safety risk assessments covering general work practices in the home and was aware of the need to assess individual service user situations in addition if particular risks arose through behaviour or care needs. Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Timescale for action 30/11/06 2 YA23 3 YA35 4 YA43 That the home ensures a suitable separate lockable cabinet is provided for medication storage 13(6) That the home arranges for all staff to be provided with formal training covering adult protection matters 18(1)(c)(i) That formal induction training is completed for all staff in the home and arrangements put in place for completion of all outstanding initial mandatory training courses for staff 26 That formal monthly monitoring visits by the proprietor are started 30/11/06 30/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations That further efforts are made to make the living environment appear more homely and that an appropriate bedside cabinet is obtained for the service user bedroom.. DS0000065938.V292097.R01.S.doc Version 5.1 Page 25 Alpha Community Care Commission for Social Care Inspection Oxford Office 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alpha Community Care DS0000065938.V292097.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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